Question

A nurse is caring for a newly admitted client who has a gastric hemorrhage and is going into shock. Identify the sequence of actions the nurse should take.

a. Administer pain relief medication, elevate the legs, and assess the client's blood pressure.
b. Assess the client's blood pressure, elevate the legs, and administer pain relief medication.
c. Elevate the legs, assess the client's blood pressure, and administer pain relief medication.
d. Administer pain relief medication, assess the client's blood pressure, and elevate the legs.

Answer 1

The correct sequence for a nurse caring for a client with a gastric hemorrhage and going into shock is to first assess the client's blood pressure, then elevate the legs, and finally administer pain relief medication.

Step-by-step explanation:

When dealing with a patient who is experiencing a gastric hemorrhage and is going into shock, identifying the sequence of actions is critical for providing the appropriate care. The correct sequence for the nurse to take is:

1. Assess the client's blood pressure – Blood pressure is a vital indicator of a patient's circulatory status, especially in the case of hypovolemic shock where there is a loss of blood volume causing a dip in blood pressure.
2. Elevate the legs – Elevating the legs helps to return blood towards the heart and can improve venous return, which is crucial for a patient in shock.
3. Administer pain relief medication – Once the patient's blood pressure has been assessed and steps have been taken to improve circulation, pain relief can be addressed to aid in patient comfort.

Therefore, among the options provided, '(b) Assess the client's blood pressure, elevate the legs, and administer pain relief medication' is the correct sequence of actions the nurse should take in this scenario.